Reducing Device-Related Pressure Ulcers: Leveraging Data and Innovation to Improve Adult/Pediatrics Outcomes

2.50
Hdl Handle:
http://hdl.handle.net/10755/602952
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Title:
Reducing Device-Related Pressure Ulcers: Leveraging Data and Innovation to Improve Adult/Pediatrics Outcomes
Other Titles:
Nursing Outcomes Based on Data [Session]
Author(s):
Kalowes, Peggy; Paige, Raquel; Messina, Valerie; Paige, Raquel; Messina, Valerie
Lead Author STTI Affiliation:
Iota Eta
Author Details:
Peggy Kalowes, FAHA, pkalowes@memorialcare.org; Raquel Paige, RN, CPN, CRRN; Valerie Messina, RN, CWCN
Abstract:
Session presented on Sunday, November 8, 2015: Significance and Background Pressure ulcers are acquired among high-risk patients in pediatric and adult hospitals, and are key indicators of the effectiveness of care. The NPUAP 1 recognizes that PUs can occur on any tissue under pressure, including beneath medical devices (MDs) used for diagnostic/therapeutic purposes. In the past two years we have reduced our quarterly prevalence of PUs (sacral, coccyx, and heel) to zero to 0.3% using an EB Skin Bundle 5 plus a 5-Layered Silicone Border Dressing* thus the direct impact of MDR PUs has become more transparent.  Stage III, IV, and Unstageable PUs are reportable as sentinel events, and are linked with litigation and lack of Medicare/Medicaid reimbursement. In 2012, using our CALNOC (Collaborative Alliance for Nursing Outcomes) nurse indicator PU data, we found a surge of MDR PUs benchmark in Pediatrics and Adult units, (5-Tracheostomy; 2-Noninvasive Ventilation Masks (NIVM); 1-IV Hub). Thus as we strive to be a high-reliability organization, we have intensified efforts to improve safety through better process re-design, changing practice to EB therapies 1-4 and building a culture of safety.   Purpose The aim of this Interprofessional performance improvement (PI) project, was to examine our on-going rate of medical device related (MDR) pressure ulcers (PUs) among pediatric and adult patients; and to institute a novel PI program for MDR PU prevention, based on evidence and innovation.    Methods The adult/pediatric advance practice nurses and the director of nursing research, convened an interprofessional team (staff nurses; MDs; PT; PI nurses; wound care specialist) who reviewed the literature, and a subsequent development of an intervention model using a rapid-cycle, Plan-Do-Study-Act (PDSA) framework.  A root cause analysis of all 8 MDR PUs in 2012 was conducted reviewing stage, location, device involved, and compliance with our standard SKIN Bundle. 4 Because of the urgency to reduce NIVM and tracheostomy-related MDR PUs, we immediately (2 nd Q, 2012), deployed the use of Mepilex® Transfer or Lite, beneath all tracheostomy neck plates and NIVM. We finalized our comprehensive MDR Prevention Model (2013), to include a new MDR PU Prevention Bundle 1,3,4 with EB interventions, including frequent skin/device assessments, moisture -reducing device interface and pressure-free device interface. * Evaluation and Discussion Our MDR Prevention Model was fully launched in 3 rd quarter, 2013. We’ve closely tracked point-prevalence/and incidence data, along team compliance with the MDR prevention bundle for the past 3 Quarters. There was an absolute reduction of MDR PUs from 0.06% incidence of stage 3+ MDR HAPU's per 1000 patient days to zero in pediatrics (benchmark 0.0 – 0.04%); and among adults from 0.28% incidence to zero with (benchmark 0.05-0.09 %,).  Thus, thru interprofessional team implementation of the MDR prevention program, and deployment of EB therapies to relieve pressure at the device–skin interface effectively, 1,3,4,5  rigorous education and continuous monitoring, we have sustained a ‘ zero’ incidence among adults and pediatric patients. These interventions can be integrated into daily workflow and result in sustained effect on nursing practice, teamwork and patient outcomes.
Keywords:
pressure ulcers; Lean; evidence based model
Repository Posting Date:
21-Mar-2016
Date of Publication:
21-Mar-2016
Other Identifiers:
CONV15C25
Conference Date:
2015
Conference Name:
43rd Biennial Convention
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Las Vegas, Nevada, USA
Description:
43rd Biennial Convention 2015 Theme: Serve Locally, Transform Regionally, Lead Globally.`

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.titleReducing Device-Related Pressure Ulcers: Leveraging Data and Innovation to Improve Adult/Pediatrics Outcomesen
dc.title.alternativeNursing Outcomes Based on Data [Session]en
dc.contributor.authorKalowes, Peggyen
dc.contributor.authorPaige, Raquelen
dc.contributor.authorMessina, Valerieen
dc.contributor.authorPaige, Raquelen
dc.contributor.authorMessina, Valerieen
dc.contributor.departmentIota Etaen
dc.author.detailsPeggy Kalowes, FAHA, pkalowes@memorialcare.org; Raquel Paige, RN, CPN, CRRN; Valerie Messina, RN, CWCNen
dc.identifier.urihttp://hdl.handle.net/10755/602952en
dc.description.abstractSession presented on Sunday, November 8, 2015: Significance and Background Pressure ulcers are acquired among high-risk patients in pediatric and adult hospitals, and are key indicators of the effectiveness of care. The NPUAP 1 recognizes that PUs can occur on any tissue under pressure, including beneath medical devices (MDs) used for diagnostic/therapeutic purposes. In the past two years we have reduced our quarterly prevalence of PUs (sacral, coccyx, and heel) to zero to 0.3% using an EB Skin Bundle 5 plus a 5-Layered Silicone Border Dressing* thus the direct impact of MDR PUs has become more transparent.  Stage III, IV, and Unstageable PUs are reportable as sentinel events, and are linked with litigation and lack of Medicare/Medicaid reimbursement. In 2012, using our CALNOC (Collaborative Alliance for Nursing Outcomes) nurse indicator PU data, we found a surge of MDR PUs benchmark in Pediatrics and Adult units, (5-Tracheostomy; 2-Noninvasive Ventilation Masks (NIVM); 1-IV Hub). Thus as we strive to be a high-reliability organization, we have intensified efforts to improve safety through better process re-design, changing practice to EB therapies 1-4 and building a culture of safety.   Purpose The aim of this Interprofessional performance improvement (PI) project, was to examine our on-going rate of medical device related (MDR) pressure ulcers (PUs) among pediatric and adult patients; and to institute a novel PI program for MDR PU prevention, based on evidence and innovation.    Methods The adult/pediatric advance practice nurses and the director of nursing research, convened an interprofessional team (staff nurses; MDs; PT; PI nurses; wound care specialist) who reviewed the literature, and a subsequent development of an intervention model using a rapid-cycle, Plan-Do-Study-Act (PDSA) framework.  A root cause analysis of all 8 MDR PUs in 2012 was conducted reviewing stage, location, device involved, and compliance with our standard SKIN Bundle. 4 Because of the urgency to reduce NIVM and tracheostomy-related MDR PUs, we immediately (2 nd Q, 2012), deployed the use of Mepilex® Transfer or Lite, beneath all tracheostomy neck plates and NIVM. We finalized our comprehensive MDR Prevention Model (2013), to include a new MDR PU Prevention Bundle 1,3,4 with EB interventions, including frequent skin/device assessments, moisture -reducing device interface and pressure-free device interface. * Evaluation and Discussion Our MDR Prevention Model was fully launched in 3 rd quarter, 2013. We’ve closely tracked point-prevalence/and incidence data, along team compliance with the MDR prevention bundle for the past 3 Quarters. There was an absolute reduction of MDR PUs from 0.06% incidence of stage 3+ MDR HAPU's per 1000 patient days to zero in pediatrics (benchmark 0.0 – 0.04%); and among adults from 0.28% incidence to zero with (benchmark 0.05-0.09 %,).  Thus, thru interprofessional team implementation of the MDR prevention program, and deployment of EB therapies to relieve pressure at the device–skin interface effectively, 1,3,4,5  rigorous education and continuous monitoring, we have sustained a ‘ zero’ incidence among adults and pediatric patients. These interventions can be integrated into daily workflow and result in sustained effect on nursing practice, teamwork and patient outcomes.en
dc.subjectpressure ulcersen
dc.subjectLeanen
dc.subjectevidence based modelen
dc.date.available2016-03-21T16:40:09Zen
dc.date.issued2016-03-21en
dc.date.accessioned2016-03-21T16:40:09Zen
dc.conference.date2015en
dc.conference.name43rd Biennial Conventionen
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen
dc.conference.locationLas Vegas, Nevada, USAen
dc.description43rd Biennial Convention 2015 Theme: Serve Locally, Transform Regionally, Lead Globally.`en
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